Mucinous Carcinoma of the breast

Bosombuddy101

I was just wondering, is the mucin or mucinous pool (without the fruit chunks) cancerous?

obsolete

Hi BB101, never really received a clear answer from any MD's on those vacant mucin pools, so I'm not sure how breast doctors interpret them. However, I do recall that one of the pathologists had considered vacant mucin pools as dirty when measuring clear margin widths, but the streaks of vacant mucin pools were NOT included in my MC tumors' measurements or staging. Additionally, pathologists don't examine 100% of breast tissue from mastectomies, just random blocks.

You ladies know far more about MC than any of the doctors with whom I had consulted, with the exception of Breast Pathologists. Many doctors do not see enough MC patients annually to be as knowledgeable as maybe patients ideally might expect them to be.

Wrong or right, I also had been left with the impression that the use or re-use of surgical instruments within the same surgical procedure is left to the surgical team's discretion.... I had been led to believe.

obsolete

bb101, Vacant mucin pools seem to be part of the same disease, but in a different disease stage ... which is how I would interpret this article.

"... Mucin-filled ducts, mucocoele-like lesions, mucinous atypical ductal hyperplasia or ductal carcinoma in situ and mucinous carcinoma may represent different stages of the same disease process...."

https://www.ncbi.nlm.nih.gov/pubmed/8971560

obsolete

Carpe, wishing you many more years of healing & blessings ....

Kelly, I had been offered RT following both my BMX and after the 2nd lumpectomy, but I had declined both. My margins had been reported as wide & acceptable. My Med Onc at a cancer center continues to push RT with UMX or BMX or LX for all his mixed MC patients, regardless of tumor size or stage.

Bosombuddy101

Obsolete,

Thank-you for that clarification-- I now recall reading that bit in the article you posted earlier. Scary to think that surgical procedures are different depending on the medical team. The expression "God is in the details" comes to mind. Meanwhile we pray for a good outcome.

obsolete

Positively in the details, BB101 OR Nurse had stated that every OR's strict protocols & sterilization procedures mandates swap-out of surgical instruments with each procedure (each breast, for example).

https://community.breastcancer.org/forum/91/topics...

https://community.breastcancer.org/forum/68/topics...

... There is also speculation that an 'alternating pattern' of malignant cell orientation may lead to a slower tumor growth pattern, due to the 'bonding' and containment benefits of the surrounding stroma.... So for women with "pure" mucinous carcinoma, breast conserving therapies might be a reasonable option. Unless the tumor is larger than 5 cm or invading the local skin, non surgical treatments are quite reasonable...

http://breast-cancer.ca/coll-carc/

August 21, 2017 By Steven Halls MD

obsolete

... The overall survival rate of patients with mu­cinous carcinoma varies little from age-matched individuals within the general population ... [exception: micropapillary pattern, etc.]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC44967...

Kellyw

I finally was able to reread and read all 66 pages- whoop.thanks for the input ladies. Anyone also have 2 intermediate oncotype scores for more than one tumor? My first tumor of 2.9cm oncotype was 18, grade 1. The 2nd tumor of .5mm was 23, grade 2. The smaller one seems to be more aggressive which is throwing me off.

obsolete

Hi Kelly, was your Grade-II MC tumor possibly "mixed mucinous" with some conventional IDC-NOS cells or was your smaller tumor perhaps a different "molecular subtype" (Luminal B vs Luminal A) than your larger Grade-I MC tumor's cellular biology? And/Or were your ER/PR/HER2 percentages maybe different in each tumor?

Best wishes as you navigate these complexities....

Kellyw

Obsolete, I'm not sure about the subtypes. My smaller tumor at 5.2 mm of higher nuclear grade of 2 had mucinous, micropapillary, and cribriform patterns. The size of the DCIS was 8.2mm but only 5.2mm was the tumor. My first tumor of 2.8cm had just cribriform. they were both strongly ER+. With the 2.9 cm tumor being 90% ER+ and the 5.2mm being 100% ER+. Both HER2-.

When I spoke to my surgeon, oncologist & 2nd opinion, they did not seem concern with trying to find the percentage of mucin even after I emailed and spoke to them directly. Both they both seem satisfied with just radiation and tamoxifen though my primary MO is "encouraging" but not pushing it.

I've ran both scenarios from NCCN guidelines for treatment of "mixed IDC" vs mucinous and it's pretty much like my 2 oncologist; one relies on the oncotype, the other on it being mucinous favorable.

obsolete

Hi Kelly, These MC tumors are mostly heterogeneous, so perhaps only a small portion of your more aggressive teeny tiny tumor had that aggressive micropapillary pattern. A less than "highly strong" PR % value can be less favorable, so it might be interesting to quiz your pathologists on your 5.2mm tumor's molecular subtype to find out if it's possibly Luminal B? If it's Luminal A, like your larger MC tumor probably is, it's maybe not a big issue.

Kellyw

thanks obsolete, I forgot to mention it was highly PR+ with the same range of the ER 90 & 100

obsolete

Kelly, a high PR % is a good thing, as you know; so probably both tumors might be Luminal A?

The other prognostic value that deserves attention is mitosis. When they calculated the Grade-II, was mitosis value a 1 or 2 or 3 on your 5.2mm tumor?

I'm sorry you were thrown a curve with intermediate Oncotype scores. That micropapillary pattern on your tiny tumor maybe accounts for a little more risk?

Kellyw

obsolete, the miotic rate was 2. Yeah I think the micropapillary highers my intermediate score. I guess the one good thing is that is only .52mm. Makes me also wondering if the biopsy caused "seeding" the biopsy MD was new to the machine and kept crabbing samples from my tumor.

obsolete

I was hoping, Kelly, your mitosis rate was NOT a "3", so middle of the road is good! Plus your tiny tumor had multiple patterns, which is common, thus your micropappilary was only a portion of your 5.2mm tumor, thank goodness.

It's irritating when MD's will not give MC patients simple info regarding % mucin vs % cellular content, pure or mixed. For me, it was like pulling teeth to get at the mucin % info also. An article had once stated that "pure" MC tends to appear lobulated on imaging, whereas "mixed" tends to look spiculated or have irregular margins. Maybe you could check your ultrasound & MRI reports?

Also, you could maybe phone Genomic Health to see if they would discuss your genomic Oncotype profiles?

obsolete

Kelly, I share your seeding concerns, especially where blood vessels break during biopsies. Mechanical displacement could be discussed with your pathologists to learn if pathology showed any evidence. Your recent mastectomy would have removed most seeding not located along the chest wall, one would think. And hopefully your pathology reports show no lymph & no vascular invasion.

You've already been through enough with your surgeries, so I send you positive healing energy for continued recovery!

Bosombuddy101

I don't know if this was posted already but here's an interesting study:

Seeding of tumour cells following breast biopsy: a literature review

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC34737...

Bosombuddy101

What are they talking about? 15% of patients is still huge! Out of 352 patients, 53 patients showed seeding 28 days after biopsy. The implications of this to patients with breast cancer is alarming!

"For example, tumour cell seeding was seen in 42% of patients when the interval between biopsy and excision was less than 15 days, but this was only seen in 15% of tumours excised more than 28 days after biopsy."

"Can tumour cells become displaced into the blood stream at the time of biopsy?

To evaluate the impact of FNA on breast cell shedding into peripheral blood, Hu and Chow [7] employed a diagnostic test applying reverse transcriptase polymerase chain reaction assay targeted against cytokeratin 19, cytokeratin 20 and the beta-subunit of human chorionic gonadotrophin mRNAs. Blood samples from 24 cases with benign breast diseases and 20 cases with malignancy were withdrawn before and within 10 min of the FNA. In 3 of the 19 patients with proven breast cancer (type not specified), the blood stream negative cases, pre-biopsy, became positive following the FNA procedure. They concluded that undertaking FNA in breast tumours may cause haematogenous dissemination of breast cells."

obsolete

Shockingly HUGE % ... Yes, very alarming! Even only one case is too many.

As many as 11 seedings or 50% shortly thereafter ... Am I reading this correctly?

And I note how this study tries to downplay & diminish those SAD ALARMING results using time as a variable.

Thankfully the British Radiological establishment had the (non-political) guts to put such shocking numbers in publication.

Thanks
for posting this, BB.

Bosombuddy101

I read 42% (148 ) of 352 patients were found to have seeding at 15 days or less between biopsy and excision. Why don't doctors look at obvious causes for poor prognosis and metastasis in early stage breast cancer patients?

Bosombuddy101

The doctors are referring to the Diaz study in that quote. I'm not sure if the 42% number is of 76 or 114 of the displacement cases? Anyway, it's still a large number of patients.

"Seventy-six cases showed tumor displacement of one or two cell clusters, and 38 cases-showed displacement of multiple tumor fragments."

AJR Am J Roentgenol. 1999 Nov;173(5):1303-13.

Are malignant cells displaced by large-gauge needle core biopsy of the breast?

Diaz LK1, Wiley EL, Venta LA.

Author information

Abstract

OBJECTIVE:

The purpose of this paper is to determine the rate of tumor displacement resulting from large-gauge needle core biopsy in patients with breast carcinoma.

MATERIALS AND METHODS:

Three hundred fifty-two cancer excisions in patients who had undergone large-gauge needle core biopsy were evaluated for evidence of tumor displacement. Three needle procedures were compared: vacuum-assisted, automated gun, and core biopsy guided by palpation. Needle track visualization, presence and amount of tumor displacement, tumor morphology, and interval between core biopsy and surgical excision were recorded for each case.

RESULTS:

Seventy-six cases showed tumor displacement of one or two cell clusters, and 38 cases-showed displacement of multiple tumor fragments. Tumor displacement was identified in 37% of automated gun specimens, 38% of specimens obtained with palpable guidance, and 23% of specimens obtained with a vacuum-assisted needle. Tumor displacement was seen in 42% of patients with an interval between biopsy and excision of less than 15 days, in 31% of patients with an interval of 15-28 days, and in 15% of tumors excised more than 28 days after core biopsy (p < .005).

CONCLUSION:

Tumor cell displacement was observed in 32% of patients who had undergone large-gauge needle core biopsy. The incidence and amount of tumor displacement was inversely related to the interval between core biopsy and excision. This relation suggests that tumor cells do not survive displacement

Kellyw

So scary!

Not sure if anyone has posted this article from MD anderson as we wait for tailorX study regarding intermediate oncotypes..

https://www.mdanderson.org/newsroom/2017/02/more-patients-with-early-stage-breast-cancer-may-be-able-to-avoi.html

Yvonne55

I felt the same way about losing a breast. My tumor was only 1.4 cm and I opted for a mastectomy. After the pathology came back it showed invasive ductile carcinoma. This means they also found cancer outside the tumor in blood vessels and lymphatic fluid. It was negative in my nodes. The surgeon told me four weeks later if he hadn't done the mastectomy he would have had to go back and do it because of the findings. My only regret is that I didn't go for a double mastectomy. I will go back and get the other one removed and then get implants. At least they will both be the same. I'm 55. I don't regret getting the mastectomy because of the findings. They were able to get all the cancer with clear margins. Good luck to you!

Bosombuddy101

Yvonne,

Did your pathology say that because you had invasive ductal carcinoma (in situ?) that it was in the blood vessels and lymphatic system and your nodes were clear? Your breast surgeon advised that because of that he would have to do a mastectomy anyway?

My regret was not getting a bilateral mastectomy right from the get go. No one likes to undergo multiple surgeries. I hope you get the results you want. Are you going straight to an implant? I guess you would have to get the tissue expander on the one side?

Ktweasel

a few posts back there was discussion about PR positive being ideal. What are the drawbacks to being PR negativewith mucinous carcinoma?

obsolete

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684304/ (ER- PR- HER2+ atypical rare case)

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http://www.yourlifesource.com/progesterone-breast-...

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http://www.yourhomeopath.org/documents/hormone/Pro...

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http://lotusrainclinic.com/why-is-the-progesterone...

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http://scienceblog.cancerresearchuk.org/2015/07/08...

obsolete

Hi KT, general info on progesterone is posted above for you. PR- approx 20% of MC.* My ER & PR were unbalanced also. Having clear nodes is said to hold higher prognostic value.

* https://wjso.biomedcentral.com/articles/10.1186/14...

------------------------------

Luminal A & Luminal B (conventional BC)

Ki-67 & PR expression

http://www.sciencedirect.com/science/article/pii/S...

Ktweasel

Obsolete- This is helpful!! Thanks!!

I am sooo tired of being in a rare category (MC, PR-, in my 40s....it's an exclusive club that I don't want to be president of LOL

wahoojen

Hi all,

I stumbled across this forum after searching online for a friend who is battling this diagnosis. She is very frustrated with local care here in Kansas City, and I'm hoping some of you can identify 'centers of excellence' (e.g. medical centers/oncologists who have deeper experience in treating this rare form of breast cancer). Can someone help her/us? She's willing to travel!

obsolete

First, sending out hugs & positive energy for healing to our MC sister who had her mastectomy surgery!!

Wahoojen, what a nice supportive friend you are to be looking out for your Kansas City friend .... we send your friend best wishes. Unfortunately, I am unable to recommend my local M.D.'s because they're really not intimate with Mucinous Carcinoma, as much as the ladies here on BCO are, because smaller hospitals actually see only a couple cases a year. I can fully understand your friend's frustrations, and please encourage her to seek out 2nd opinions. One would think that NCCN centers would have the opportunity to see many more MC patients. NCCN centers:

https://community.breastcancer.org/forum/51/topics...

• Fred & Pamela Buffett Cancer Center, Omaha, NE
• Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
• City of Hope Comprehensive Cancer Center, Duarte, CA
• Dana-Farber/Brigham and Women's Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA
• Duke Cancer Institute, Durham, NC
• Fox Chase Cancer Center, Philadelphia, PA
• Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
• Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA
• The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
• Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
• Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ; Jacksonville, FL; Rochester, MN
• Memorial Sloan Kettering Cancer Center, New York, NY
• Moffitt Cancer Center, Tampa, FL

• The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH
• Roswell Park Cancer Institute, Buffalo, NY
• Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO
• St. Jude Children's Research Hospital/The University of Tennessee Health Science Center, Memphis, TN
• Stanford Cancer Institute, Stanford, CA
• University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
• UC San Diego Moores Cancer Center, La Jolla, CA
• UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
• University of Colorado Cancer Center, Aurora, CO
• University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
• The University of Texas MD Anderson Cancer Center, Houston, TX
• University of Wisconsin Carbone Cancer Center, Madison, WI
• Vanderbilt-Ingram Cancer Center, Nashville, TN
• Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT

NCCN professional guidelines for breast cancer:

https://www.nccn.org/professionals/physician_gls/f...

This thread's resident senior expert, VR, had previously posted this link to a "rare breast cancer lab":

https://www.mskcc.org/research-areas/labs/jorge-re...

My limited experience taught me that some of the Breast Pathologists were in the know regarding the who's who's in the treatment of special rarer breast cancers. Unfortunately, my employer's health insurance provider put me into a HMO plan where I need to stay within network, although I had roamed outside of network for 2nd opinions and outside consultations (out of pocket $). Best wishes!